MEDICARE: MRS. SHAWISHI LUCKIE CHRISTMAS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0196984	CO

General Provider Information

NPI Number	:	1922441674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWISHI LUCKIE CHRISTMAS RN

Provider Business Mailing Address
First Line	:	2740 WABASH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2544
Country	:	US
Telephone Number	:	303-564-8435
Fax Number	:	303-321-3496

Provider Business Practice Location Address
First Line	:	2740 WABASH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-2544
Country	:	US
Telephone Number	:	303-564-8435
Fax Number	:	303-321-3496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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